IDENTIFICATION DATA: A 78-year-old male. REASON FOR CONSULTATION: The patient is scheduled for total hip replacement, who has hypertension, hypercholesterolemia, possible peripheral vascular disease, previous smoker. He is a patient of Dr. John B. Luster. Surgery is scheduled for August 1, 2006.
HISTORY OF PRESENT ILLNESS: I saw the patient today, who is scheduled for total hip replacement on the left. He has markedly limited excercise capacity to this, and has a history of hypertension, hypercholesterolemia, and was a previous smoker. He has not had any chest pain or angina, but does not do much exertion to be able to provoke this. He also has no history of previous myocardial infarction. No typical exertional chest discomfort. There are no congestive heart failure symptoms that are obvious. He has a history of borderline hypertension, for which he was started on Plendil. He also has hypercholesterolemia and smoked until 1998. He has no diabetes, no family history of premature coronary artery disease. He has no history of heart murmurs, palpitations, dizziness, or syncope. No neurological symptoms. deep venous thrombosis, intermittent claudication. ALLERGIES: He has no known drug allergies.
CURRENT MEDICATIONS: Voltaren 50 mg a day; as well as Plendil 2.5 mg a day. REVIEW OF SYSTEMS: Aside from that as mentioned above, is not contributory, except for inguinal herniorrhaphy.
PHYSICAL EXAMINATION: VITAL SIGNS: On examination his vital signs are pulse of 78, blood pressure 136/80, respirations 14. Jugular venous pressure is elevated. NECK: Carotids are 2+ bilaterally, without bruits. CARDIOVASCULAR: S1, S2 with a short aortic ejection murmur. No signs of congestive heart failure or pericardial rub. CHEST: Clear to auscultation and percussion. ABDOMEN: Soft and nontender. No hepatosplenomegaly or masses. Normal bowel sounds. EXTREMITIES: Femoral pulses 1+ bilaterally, with posterior tibial and dorsalis pedis are not palpable bilaterally. NEUROLOGIC: No focal signs. LABORATORY AND OTHER DATA: EKG shows sinus rhythm, within normal limits. IMPRESSION 1. The patient is preoperative for hip surgery, with multiple risk factors of coronary artery disease, including hypertension, hypercholesterolemia, previous smoking, and probable peripheral vascular disease with absent distal pulses. Need to rule of significant coronary artery disease.
3. Hypercholesterolemia, not on treatment.
5. Absent distal pulses suggesting peripheral vascular disease/Buerger's disease from smoking.
PLAN 1. I recommend adenosine Cardiolite. Provided the adenosine Cardiolite test reveals no or a very small area of reversible ischemia, we feel the patient is at mildly increased cardiac risk for the planned surgery. If there indeed is a small area of reversible ischemia, will require beta blockade prior to performing any surgery. If the adenosine Cardiolite scan shows a large area of reversible myocardial ischemia, will then require further evaluation prior to a total hip replacement.
2. Would like to see a copy of his past medical profile, and if necessary get his LDL to a goal of less than 100.
3. Further management dictated by the results of the above mentioned adenosine Cardiolite scan. I would continue his Plendil for the present . Thank you for this referral, Dr. Luster.
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A fishy recommendation: omega-3 fatty acidintake in pregnancyDepartment of Obstetrics and Gynecology, Faculty of Medicine, University of Alberta, Edmonton, Alberta, CanadaCorrespondence: Dr SJ Genuis, University of Alberta, 2935-66 Street, Edmonton, Alberta, Canada T6K 4C1. Email [email protected] cite this paper as: Genuis S. A fishy recommendation: omega-3 fatty acid intake in pregnanc